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Exercise after a cesarean birth

A cesarean birth or C-section is a major surgical procedure causing scars to many different tissues and layers in the stomach. After a C-section it is very common to experience pain and swellings in the abdominal area. This major surgery can cause your digestive system to also slow down as well. This can result in more gas formation as well as constipation.

A changed sensitivity over the stomach is also common. You should after a C-section avoid carrying more than the weight of the child the first 6-8 weeks. In addition, you should also use a special technique when getting out of bed and laying sideways to decrease the pressure of the newly operated stomach. It’s often comforting to keep a pillow over your stomach while coughing or going to the bathroom.

Exercising during the first week

The first phase of the healing process is often called “the emergency phase” and it applies to the first week after birth. During this time swellings and pain in the stomach is very common. Any activity or exercise which puts strains on the abdominal muscles or pulls on incision should be avoided. It’s also important to get out of bed and to move your body.

Walking after c-section is encouraged and should be your go to for the first few weeks. You’ll start to notice day to day movement getting easier and less discomfort lifting baby or moving around. Core breathing can also be helpful. Take a deep breath in through your nose, letting your rib cage widen into your hands and your abdomen expand. Keep your upper chest, neck and shoulders relaxed as you breathe in. As you breathe out through your mouth, allow your abdomen and chest to fall. Exhale completely. Remember to breathe slowly.

Even if you didn’t have a vaginal birth, the pelvic floor has still been put under heavy pressure during the pregnancy and it is therefore recommended that you begin to exercise the pelvic floor muscles. During the first weeks it’s enough to do light and short clenches to increase the circulation to the pelvic floor and to stimulate the recovery. Try to keep the clenches with a light or middle force for about 2 seconds and repeat 5 to 10 times, 3 times a day. Make sure to release your grip completely between the clenches.

Exercising during the second to eighth week

The second phase is called the “reparation phase” and goes for up to 6 weeks. That’s when you begin to see scars form on the stomach. During this entire phase until around 8 weeks after the pregnancy the restrictions on physical activity still apply. This means you should be cautious with, for instance, getting out of a sofa, lifting a stroller into the car and pushing the stroller up a hill. However, it can be a good time to begin taking shorter walks. Generally, most doctors don’t recommend strenuous exercise or heavy lifting for at least six weeks post-surgery.

You can also, if you want, start with lighter home exercises without weights for legs, thighs and arms. All exercises should feel okay to perform and should not give rise to additional symptoms. You can now definitely extend the training of the pelvic floor with some strength clenches and endurance clenches. A strength clench has the same technique as with the identification clench but with a force that shall remain in 5-8 seconds and be repeated 5-10 times. Endurance clench means that you, with a reasonable force, keep the pinch for 20-60 seconds and repeat 1-2 times. You should keep your daily pelvic floor training for around 3-6 months or for as long as you feel that it is needed.

Exercising from the eighth week to a year

The third phase can be considered to be the recovery phase and means that the scars successively become stronger and stronger. This phase goes on for up to a year after the pregnancy. Now most of the restrictions you have had during the beginning after the C-section no longer apply and the purpose of the training is now to slowly but surely rebuild the strength of your body in your daily life and increase the level of your training. It is now completely fine to begin a more specific stomach exercise.

After 12 weeks studies show that the tissues have regained 80% of their original capacity. Therefore it may be a good idea to wait at least 3 months before you can go back to jogging, jumping exercises and heavy lifting which put your stomach under high pressure. It is also very essential to listen to your body as the recovery spans over the entire first year. Training shall not increase or cause symptoms. If the training does that, then it’s simply too heavy and you would need to decrease the level and go back one step or two.

If something doesn’t feel good when you exercise

We all have different bodies so it is impossible to give general advice which applies to all individuals. Your earlier training habits, your well being and activity during pregnancy, how it went when you gave birth and your genetics are just some factors playing a role as to how your body will feel after the pregnancy and how it reacts to training. It’s therefore important to seek help if you experience something that doesn't feel good. If you have issues or you feel unsafe, don’t hesitate to contact your midwife or physiotherapist for help as they have competence within the healthcare of women.

Sources: - Svensson-Raskh et al. 2021. Mobilization Started Within 2 Hours After Abdominal Surgery Improves Peripheral and Arterial Oxygenation: A Single-Center Randomized Controlled Trial
- Regberg Lundborg. Balkong Förlag 2017. Gravidkraft - Hälsa genom rörelse och träning - Fernando, Winblad. Fri Tanke 2019. Kejsarfödsel: Snittkoll och mammaroll. - Lind, Rotstein, Fernando, Olsson. Gothia fortbildning 2020. Bäckenbotten och förlossningsskador - Handbok för barnmorskor
- Goom et al. 2019. Returning to running postnatal - guideline for medical, health and fitness professionals managing this population.